1.J. Round table: Research Methods for Public Health Oriented Health Services Research – what works where and for what?

Abstract   This workshop will present the different methodological approaches relevant to the field of public health. This includes approaches of health systems and health policy research, epidemiology, health technology assessment, health impact assessment, health systems performance and economic evaluations. Presentations will be hold by presidents and vice-presidents of the EUPHA Sections in the form of a panel, presenting the overview of each methodology and providing case examples. All organizers might invite special contributions from their members and students to share innovations of case examples from their counties. During the first half of the workshop the EUPHA Sections will provide input on traditional and innovative methods the following topics: 1. Health Policy and Systems Research (HPSR) applied to Primary Care. 2. The use of traditional and innovative epidemiological study designs for public health relevant inferences. 3. Overview of methods used for the quantification of health impacts, both following a risk assessment approach or an epidemiological approach. 4. Methodologies and techniques applied in Health Technology Assessment (HTA) and how their contribute to decision-making and evidence-informed policymaking. 5. Health Systems Performance Assessment (HSPA) and Economic evaluations. 6. Research methods from the public health policy and politics perspective. In the second half of the workshop we will discuss and share examples on innovation in research methods and seek to find an answer to the question: what is being done in the countries? Input from DGPH-FO, DNVF-IHRS, Charité WG HPSRI and from all participants will be welcome. Target audience: young and old professionals interested in updating their methods skills and sharing their own experiences on innovation in methods for a stronger public health research. Key messages • There are no better or worse research methods; they are just a tool, that when applied properly support evidence and action for a stronger public health. • As knowledge on research methods evolve, sharing knowledge amongst different fields is key to contribute to a stronger health system, better health policy decisions and a better health for all. Speakers/Panellists Lorena Dini Charité Univesitätsmedizin Berlin, Berlin, Germany Piedad Martin-Olmedo Escuela Andaluza de Salud Pública, Granada, Spain Stefania Boccia Italian Society of Hygiene, Preventive Medicine and Public Health, Rome, Italy Chiara de Waure University of Perugia, Perugia, Italy João Vasco Santos Faculty of Medicine, University of Porto, CINTESIS, Porto, Portugal


Background:
Health inequalities are well documented empirically. However, it is unclear whether health inequalities persist in very old age (continuity), whether they accumulate steadily (accumulation), or whether they even attenuate in old age (convergence) -not least because of social inequalities in life expectancy, which make it less likely for individuals with lower social status to reach old age at all. The aim of this study is to empirically test these three hypotheses.

Methods:
The analyses are based on representative cross-sectional data from 1,863 very old people and panel data from 912 participants in the 1st and 2nd wave (W1, W2) living in North Rhine-Westphalia the largest federal state in Germany (NRW80+ study). Health outcomes of the analyses are subjective health, multimorbidity and need for long-term care. Indicators of socioeconomic status (SES) are education, occupational status, and net equivalent income. Regression models (linear, logistic, ordinal) are used to analyze crosssectional and longitudinal data. Panel selectivity is also considered by means of a failure model.

Results:
Cross-sectional findings show health inequalities for all SES variables: persons with low education and low income have poorer subjective health and higher need for care. Low status is associated with higher need for care. Preliminary results from longitudinal analyses show a slight increase in health inequality: low income and low status are associated with higher multimorbidity and low education with higher dependency on long-term care at W2.

Conclusions:
Despite the socially conditioned unequal chances of reaching old age, health inequality is still present in very old age and even increases slightly over time. The results argue against the convergence hypothesis and in favor of the continuity or even the accumulation hypothesis. A better understanding of the mechanisms leading to the persistent inequality is needed to development targeted interventions also in old age. Key messages: Health inequalities persist and even increase in very old age (80+). It is imperative that the oldest old -an increasingly large population group -be considered when designing strategies to reduce health inequalities. 3. Overview of methods used for the quantification of health impacts, both following a risk assessment approach or an epidemiological approach. 4. Methodologies and techniques applied in Health Technology Assessment (HTA) and how their contribute to decision-making and evidence-informed policymaking. 5. Health Systems Performance Assessment (HSPA) and Economic evaluations. 6. Research methods from the public health policy and politics perspective.
In the second half of the workshop we will discuss and share examples on innovation in research methods and seek to find an answer to the question: what is being done in the countries? Input from DGPH-FO, DNVF-IHRS, Charité WG HPSRI and from all participants will be welcome. Target audience: young and old professionals interested in updating their methods skills and sharing their own experiences on innovation in methods for a stronger public health research. Key messages: There are no better or worse research methods; they are just a tool, that when applied properly support evidence and action for a stronger public health. As knowledge on research methods evolve, sharing knowledge amongst different fields is key to contribute to a stronger health system, better health policy decisions and a better health for all.